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UNV-12110
KIMBERLLY DRISCOLL
D4AYOR
CITY OF SAIX. f, NLASSACHUSETTS
BoAm or Hi:.kuri-i
120 WASHINGTON STRF,F,.T, 4'" FLOOR
'I'El.. (978) 741-1800 FAX (978) 745-0343
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,DOFF, Well Construction Permit Application
Fee: $180. Check payable to the City of Salem (no cash. No charge for monitoring wells)
Date:9 t�3 T eWSorry, swwsa yv� �w.,e; 0j COr(1�
Location: in�rrsono� wzdb,ru cu�eT4^ I�c�a szc�et Salem, MA. 01970
Owner: 8Iwc-t Goar t5mS ddress enk Ftry, u l u---ur Tel.
.1 tlnL c.,�an, racy c^'� 11I
Type of well: non;hx,'.,n t. ell Well use: mon-oe,-p :;.e
Well Contractor: Ocap k Pump ontractor: At,— Address: ew +a* Ht.rr�tlS�-CQ0 vrr�cynrm Address: 6,,12uos7 c�.MUr�gS r1.('� w icon u�
Phone: S-ObCV-.) G-: ,3q ti Phone: 7i3t ,g3Q,9-im
Reg. M
Have abutters been notified? (y)X, How? ee ^} I Phor-,e c-oll%
In the space provided below (or on back) show the location of the proposed well in relation to existing or proposed above
or below ground structures. A description of visible prior and current land use within (200) feet of the proposed well
location, which represent a potential source of contamination.
There is no fee for monitoring wells but a permit is required for installation.
B.O.H. use only Check # Check date: Permit #,
Well const permit appl. UPDATED 5/23/11
APPROXIMATE
RAM AREA
12 WOODBURY
:,rl/ Afill COURT
ST.
GONYEA
PARK
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APPDXINIATE Nit
RIVER BANK
RD
cp
BRIDGE
KEY Al" PROJECT NUMBER FIGURE NUMBER:
RELEASE ABATEMENT MEASURE-- .1 052.75079.0137 2
190 BRIDGE STREET (-. YM
SALEM,MASSACHUSETTS O-xss6cf`7TES fNC- SCALE: DATE:
RTN 3-10900 600 West Cummings Park Suite 5450 NTS 6/20/12
Woburn, Massachusetts 01801 FILE: DRAWN BY: CA
T&(7BI)932-900.Fax.(M)932-621 RAM FICURES CHECKED BY: IF
APPDXIMATE
RIVER BANK
APPROXIMATE
RAM AREA
12 WOODBURY
COURT
11
-N T
'� STg i
IT Si.
GONYEA
PARK
BRIDGE
KEY MAP-
RELEASE ABATEMENT D�ASUAE
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ROJECT NUMBER
PAM
052.75079.0137
FIGURE NUMBER:
2
190 BRIDGE STREET
SALEM, MASSACHUSETTS
KSS o"CIATESINC:
SCALE:
DATE:
RTN 3-10900
600 West Cummings Park Suite 5450
NTS
6/20/12
FILE:
RAM ]•'liaURF.$
DRAWN BY: CA
CHECKED BY; IE
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Woburn, Massachusetts 01801
TeL(181)S3?'9400 Faz(%81)932fi211
July 2012
To Whom It May Concern:
I am in the process of updating our Well Regulation records. At you convenience, would
you please send me your latest Well Regulations for testing "Private Well' water?
Should you have any questions, please do not hesitate to contact me. I thank you in
advance for your time and cooperation.
Sincerely,
Xeff# JqCVi and
ETR Laboratories, Inc.
60 Elm Hill Ave, Ste 1
Leominster, MA 01453-4864
800-344-9977
Fax: 978-534-4250
Email: kellyna,etrlabs.com